Term
| CNS Depressants - general info |
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Definition
1. Sedative-hypnotics = dose dependent; at low doses, calm the CNS without sleep; at high doses, calm the CNS to the point of sleep
Classified into three main groups:
barbiturates
benzodiazepines
miscellaneous drugs |
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Term
| barbiturates - definition |
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Definition
| a class of drugs that are chemical derivatives of barbituric acid. They are used to induce sedation |
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Term
| benzodiazepines - definition |
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Definition
| a chemical category of drugs most frequently prescribed as anxiolytic drugs and less frequently as sedative-hypnotic agents |
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Term
| Gamma-aminobutyric acid (GABA) |
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Definition
| primary inhibitory neurotransmitter found in the brain. A key compound affected by sedative, anxiolytic, psychotropic, and muscle relaxing medications |
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Term
| Benzodiazepines - CNS Depressant |
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Definition
1. formerly the most commonly prescribed sedative- hypnotic drugs
2. nonbenzodiazepines currently more frequently prescribed
3. favorable drug effect profiles, efficacy and safety
4. classified as either:
a. sedative-hypnotic
b. anxiolytic (medication that relieves anxiety |
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Term
| Benzodiazepines - Adverse Effects |
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Definition
| 1. headache 2. drowsiness 3. dizziness 4. cognitive impairment 5. vertigo 6. lethargy 7. fall hazard for elderly pts 8. hangover effect/daytime sleepiness 9. paradoxical excitement/nervousness 10. rebound insomnia with abrupt discontinuation |
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Term
| Benzodiazepines - Toxicity and Overdose |
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Definition
causes somnolence, confusion, coma, diminished reflexes - usually does not cause hypotension and respiratory depression unless taken with other CNS depressants such as alcohol or barbituates - unless taken with these it will rarely result in death
Treatment: symptomatic and supportive Flumazenil is an antidote - reverses sedative effects |
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Term
| Benzodiazepines - summary note |
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Definition
1. to relieve acute anxiety attack such as a panic attack---good choice
2. suppress REM sleep to a degree (not as much as barbiturates), thus hangover effect
3. contraindication in pregnancy (Category D)
4. if taken with alcohol - excessive respiratory depression - overdose fatal
5.taper when discontinuing
6. antidote is flumazenil (Romazicon) |
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Term
Nonbenzodiazepines -
zalepion |
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Definition
1. aka Sonata
2. short acting hypnotic
3. unique advantage of this drug stems from very short half life
4. can take a dose in middle of night as long as it is 4 hours from time to get up |
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Term
Nonbenzodiazepines -
zolpidem |
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Definition
1. aka Ambien
2. short acting hypnotic
3. relatively short half life and lack of active metabolites contribute to lower incidence of daytime sleepiness
4. a unique dosage form, Ambien CR, is longer acting form with two separate drug reservoirs...one to fall asleep quickly, the other to release more slowly through the night to maintain sleep
5. concern is somnambulaton (sleepwalking)
6. one of two hypnotics FDA approved |
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Term
| Nonbenzodiazepines - Hypnotics - General Info |
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Definition
1. share many characteristics of benzodiazepines
2. used to treat insomnia
3. Examples: zalepion (Sonata); zolpidem (Ambien);p eszoplicone (Lunestra); ramelteon (Rozerem)
4. Eszoplicone and extended released zolpidem (Ambien CR) approved for long term therapy
5. Ramelteon (Rozerem) - does not cause CNS depression, no potential for abuse, no withdrawal signs and symptoms |
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Term
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Definition
1.Used to relieve anxiety, stress, and restlessness and to promote sleep
2. may cause temporary yellow skin discoloration extended, continued intake) and visual disturbances
3. otential interactins with alcohol, barbiturates, and psychoactive drugs
4. contraindicated in liver disease, alcoholism, other conditions
5. pt should not operate heave machinery during use |
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Term
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Definition
1. used to relieve anxiety, restlessness, and sleep disorders
2. may cause CNS depression, hepatotoxicity, nausea, vomiting, anorexia, restlessness, insomnia
3. may interactions including CNS depressants, MAOIs, phenytoin, warfarin, alcohol
4. contraindicated in cardiac and liver disease
5. pt should not operate heavy machinery during use |
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Term
| Barbituates - General info |
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Definition
1. 1st introduced in 1903; were standard drugs for insomnia and sedation
2. habit forming; low therapeutic index - above range becomes toxic
3. only a handful commonly used today due in part to safety and efficacy of benzodiazepines |
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Term
| Barbituates four Categories |
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Definition
1. ultrashort-acting - anesthesia for short surgical procedures, anesthesia induction, control of convulsions, reduction of intracranial pressure in neurosurgical pts.
2. short acting - sedation and control of convulsive conditions
3. intermediate acting - sedation and control of convulsive conditions
4. long acting - sleep induction, epileptic seizure prophylaxis |
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Term
| Barbituates adverse effects |
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Definition
drowsiness, lethargy, dizziness, hangover, paradoxical restlessness or excitement. long-term effect on sleep architecture can be detrimental..deprive pts of REM sleep - causes agitation and inability to deal with normal stress. rebound phenomenom can occur
Cardiovascular - vasodilation,hypotension
CNS - drowsiness, lethargy, vertigo
Respiratory - respiratory depression, cough
GI -nausea, vomiting, diarrhea, constipation
hematolologic - agranuloctosis, thrombocytopenia
other - hypersensitivity reactions, stevens-johnson syndrome |
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Term
| Barbituates - toxicity and overdose |
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Definition
1. overdose frequently leads to respiratory depression and subsequent respiratory arrests
2. overdose produces CNS depression (sleep to coma and death)
3. Can be therapeutic - anesthesia induction, uncontrollable seizures - phenobarbital coma
Treatment is
symptomatic and supportive
maintain adequate airway
assisted ventilation/ oxygenn therapy
fluids
pressor support
activated charcoal |
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Term
| Muscle Relaxants - general information |
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Definition
1. act to relieve pain associated with skeletal muscle spasms
2. majority are centrally acting - CNS is site of action; similar in structure to other CNS depressants
3. direct acting - act directly on skeletal muscle; closely resemble GABA
4. most effective in conjunction with rest and physical therapy |
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Term
| Muscle Relaxants - Contraindications |
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Definition
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Term
| Muscle Relaxants - adverse effects |
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Definition
1. extension of effects on CNS and skeletal muscles
2. euphoria
3. lightheadedness
4. dizziness
5. drowsiness
6. fatigue
7. muscle weakness
8. diarrhea, GI upset, headache, slurred speech, muscle stiffness, constipation, sexual difficulties in males, hypotension, tachycardia, weight gain |
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Term
| Muscle Relaxants - Summary Note |
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Definition
1. have a depressant effect on CNS
2. pt should be taught importance of taking measures to minimize self-injury and falls related to decreased senorium |
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Term
| Nursing Implications Card 2 |
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Definition
Safety is important
keep side rails up or use bed alarms
do not permit smoking
assist pt with ambulation - esp the elderly
keep call light w/in reach
Monitor for therapeutic effects
increased ability to sleep at night
fewer awakenings
shorter sleep-induction time
few adverse effects such as hangover effects
improved sense of well being because of improved sleep
for muscle relaxants: decre3ased spasticity , decreased rigidity |
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Term
| Muscle Relaxants - in general |
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Definition
1. with exception of dantrolene (Dantrium), which acts directly on skeletal muscle tissues, muscle relaxants are classified as centrally action drugs because of their site of action in the CNS
2. some evidence suggests that carisoprodol has abuse potential; however,it and other muscle relaxants are not controlled substances
3. contraindicated in pts who have compromised pulmonary function, active hepatic disease, or impaired myocardial function |
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Term
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Definition
1. aka Lioresal
2. available both oral and injectable dosage forms
3. injectable form is for use with an implantable baclofen pump device
4. with this route, a test dose needs to be administered initially to test for a positive response
5. the injection is diluted before infusion |
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Term
cyclobenzaprine
Muscle Relaxant |
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Definition
1. aka Flexaril
2. available in a 5 mg and 10 mg dose and an extended release formulation (Amrix)
3. centrally acting and is structurally and pharmacologically related to the tricyclic antidepressants
4. most commonly used drug in this class to reduce spasms following musculoskeletal injuries
5. very common to have marked sedation from use |
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Term
| Nurse diagnosis for pt who recieved sedative hypnotic drug |
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Definition
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Term
| a pt admitted to emergency dept after taking overdose of barbituate - which drug is antidote |
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Definition
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Term
| nurse would monitor older adults who are prescribed a benzodiazepine for treatment of insomnia for which potential side effect |
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Definition
| ataxia (lack of coordination) |
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Term
| the pts chart notes that the administration of dantrolene (Dantrium) immediately postoperatively. The pt has probably experienced |
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Definition
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Term
| Midazolam has been ordered for pt to be administered by injection 30 minutes prior to colonoscopy. Nurse informs of common side effect: |
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Definition
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Term
| a pt aske about Ambien. Nurse knows |
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Definition
Ambien is Pregnancy C med
less likely to cause morning grogginess
should be limited to 7-10 days |
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Term
| antidote to benzodiazepine overdose |
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Definition
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Term
| when providing education to pt on the use of benzodiazepine medication the nurse should include |
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Definition
| using medication may cause drowsiness the next day. hangover effect b/c interferes with REM sleep. Do not use with alcohol. Do not drive. |
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Term
| an elderly pt taking multiple meds has a barbituate added. Nurse should expect |
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Definition
| to administer half of the usual dose of barbituate - associated with increased falls in the elderly. |
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Term
| Barbituates have a low therapeutic index. This means |
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Definition
| the effective, sage dose range is narrow - above that range they are rapidly toxic |
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Term
| Barbiturates such as phenobarbital deprive people of |
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Definition
| REM sleep, which can result inagitation and the inability to deal with normal stress |
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Term
| Baclofen (Lioresal is available as an |
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Definition
| injectable form for use with an implantable pump device |
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Term
| Cyclobenazprine (Flexeril) often results in |
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Definition
| deep sedation and sleepiness. Pts taking muscle relaxants are at a risk to develop hypotension; therefore they should be taught safety measures to prevent falls. |
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Term
| Benzodiazepines such as diazepam are used as ________________ or sedatives |
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Definition
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Term
| Zolpidem is used as a hypnotic for |
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Definition
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Term
| Phenobarbital is not used as an anxiolytic but is used for |
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Definition
| statis epilepticus control |
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Term
| Cyclobenzaprine is a __________, not to reduce ______________. Most commonly used to reduce spasms after |
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Definition
| muscle relaxant; anxiety; musculoskeletal injury |
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Term
| Ramelteon is contraindicated in cases of severe |
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Definition
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Term
| Epzopiclone (Lunestra) is approved for |
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Definition
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